Long-term Outcome of the Retrourethral Transobturator Male Sling After Transurethral Resection of the Prostate

Abstract

PurposeTo evaluate long-term outcomes of AdVance and AdVanceXP male slings in patients with persistent stress urinary incontinence (SUI) after transurethral resection of the prostate (TURP).MethodsA total of 18 consecutive patients received AdVance (n=14) or AdVanceXP (n=4) male sling implantation between 2007 and 2013. Continence was determined by pad use, 24-hour pad testing and validated questionnaires (International Consultation on Incontinence Questionnaire Short Form, ICIQ-SF). Quality of life was evaluated by International Quality of Life (IQoL) score. Patient satisfaction was measured with patient’s global impression of improvement score. Cure was defined as 0–5 g in the 24-hour pad test. Statistical analysis included Fisher exact and Wilcoxon test (P<0.05).ResultsFollow-up was available for 15 patients who underwent further analysis. After a median follow-up of 70 months (range, 18–83 months), mean daily pad usage was 1.8±2.1 pads (P=0.015 vs. baseline level). Mean IQoL score was 66.4±31.6 (P=0.050 vs. baseline level), and mean ICIQ-SF score was 9.5±6.6 (P=0.077 vs. baseline level). Based on 24-hour pad testing, mean daily urine loss was 31.2±64.5 g (median, 0 g; range, 0–209 g). Cure rate was 46.7%, and cure-and-improved rate was 60.0%. Assessing predictive features for success, better results were found in patients who needed up to 4 pads preoperatively (P=0.041) as well as for patients ≤71 years at the time of implantation (P=0.041).ConclusionsThe findings indicate that AdVance and AdVanceXP implantation can be performed effectively and safely in men suffering from SUI after TURP. However, long-term success rates seem to be lower compared to SUI after radical prostatectomy and patients should be counseled accordingly.

Outcome and complications of adjustable continence therapy (ProACTTM) in the treatment of urinary incontinence after transurethral resection of the prostate: A multicenter study

“…A successful outcome was described in 78% of the patients with divergent definitions of success (total continence, <2 g loss of urine, ≥50% pad reduction, and subjective improvement in continence) . Another study (not included in the above review), reported results of 15 post‐TURP patients treated with a male sling with a median follow‐up of 70 months . The outcome on continence after implantation of the male sling was improved with a greater than or equal to 50% pad reduction in 60% of the patients, including, 47% dry patients …”

“…Another study (not included in the above review), reported results of 15 post‐TURP patients treated with a male sling with a median follow‐up of 70 months . The outcome on continence after implantation of the male sling was improved with a greater than or equal to 50% pad reduction in 60% of the patients, including, 47% dry patients …”

“…22 Another study (not included in the above review), reported results of 15 post-TURP patients treated with a male sling with a median follow-up of 70 months. 23 The outcome on continence after implantation of the male sling was improved with a greater than or equal to 50% pad reduction in 60% of the patients, including, 47% dry patients. 23 It would be interesting to perform trials, preferably randomized, comparing adjustable continence balloons in the treatment of male SUI with other devices, such as a male sling or AUS.…”

“…23 The outcome on continence after implantation of the male sling was improved with a greater than or equal to 50% pad reduction in 60% of the patients, including, 47% dry patients. 23 It would be interesting to perform trials, preferably randomized, comparing adjustable continence balloons in the treatment of male SUI with other devices, such as a male sling or AUS. To prevent mixed patient populations, future studies should differentiate between patients who have post-radical prostatectomy SUI and those who have post-TURP SUI.…”

Belastungsinkontinenz nach operativer Therapie einer benignen Prostatahyperplasie: Konservative und operative Therapieoptionen

“…Es existiert lediglich eine Studie, die sich auf die Analyse der AdVancebzw. AdVanceXP-Schlinge nach TURP fokussierte [34]. Hierbei wurden insgesamt 18 konsekutive Patienten mit einem medianen Follow-Up von 70 Monaten eingeschlossen.…”